The Downside of Doctors Who Feel Your Pain

Monday

The ideal physician surely possesses both competence and compassion. Will our quest to eradicate the coldhearted doctor be another fad with consequences we may regret?

When I started my medical internship, my father the doctor told me that when he was an intern, the competence of his colleagues was inversely proportional to how much their patients liked them. My heart sank. I had the likability market covered.

You wanted eye contact? I could give you eye contact. You wanted someone to nod and say, “I understand your pain”? Empathy may as well have been my middle name.

But actually tending to the acute medical issues of sick patients in the middle of the night? Interpersonal skills alone were not going to cut it.

Medicine, like education, business and fashion, is subject to fads. Hormone replacement therapy. Radical mastectomy. Bloodletting.

The latest? Breeding nice doctors. It’s all the rage.

A wealthy Chicago couple recently donated $42 million to the University of Chicago Medical Center for the creation of an institute to improve the doctor-patient relationship. Many medical schools are weeding out candidates who communicate poorly. And now, to become licensed physicians, medical students must pass a “clinical skills” exam assessing, among other proficiencies, how well they acknowledge patient concerns, ask about feelings and show empathy.

The ideal physician surely possesses both competence and compassion. But will our quest to eradicate the coldhearted physician know-it-all be another fad with consequences we may later regret?

How do we even measure these skills? During one of my clinical training sessions, a patient told me no physician had ever made her feel more at ease. The next cautioned that I made too much eye contact, sat too close and “invaded” her personal space. After briefly feeling like a sex offender, I realized the process, though well intentioned, was flawed.

Proponents of weeding out students who lack interpersonal skills argue that communication errors are at the root of medical mistakes. But we have no data to suggest that medical students who sit close but not too close make any fewer mistakes than their less-communicative colleagues. The awkward student in the corner who obsessively follows a checklist may make fewer procedural mistakes than his charming friend who lights up the room.

In fact, qualities suggestive of extroversion do not necessarily track with leadership or altruism. Adam Grant, an organizational psychologist at the Wharton School of the University of Pennsylvania, recently led several studies suggesting that extroverts, when grouped together, competed excessively and undermined productivity. The introverts were better listeners and enhanced group performance. With the future of health care uncertain, do we want to be turning away these cooperative, albeit reticent minds?

I worry, finally, that this focus on interpersonal skills inevitably feeds our cost and quality crisis.

As a runner with serial overuse injuries, I am as guilty as anyone of conflating the most sympathetic doctor with the one who gives me what I want — for me, always an M.R.I. But in a culture that values novel technology above all else, undue emphasis on interpersonal skills may make it only more difficult for patients to discern good medicine from that which makes us feel most understood.

The beauty of clinical medicine is that we constantly question our latest wisdom. How we select and train medical students may be more difficult to evaluate than the effect of a vitamin supplement, but that does not excuse us from subjecting our novel approaches, including an emphasis on glad-handing patients, to the same investigative rigor.

I like to think my father was wrong about the relationship between clinical acumen and interpersonal skills. Regarding another piece of wisdom he shared, however, I’m certain he is right.

“Dad,” I often asked as a child, “who is smarter, you or Mom?”

“Well, Lisa,” he would answer, “there are different kinds of smart.”

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